重症医学科导管相关性血流感染患者流行病学特点及危险因素分析  

Epidemiological characteristics and risk factors of catheter-related bloodstream infections in ICU patients

作　　者：尹德荣 苏海萍 赵凤琴 尤晶 季娟 年清萍 

机构地区：[1]青海省心脑血管病专科医院质控科,青海西宁810012

出　　处：《中华医院感染学杂志》2017年第19期4375-4377,4385,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81260299)

摘　　要：目的分析重症医学科导管相关性血流感染患者流行病学特点及危险因素。方法选取2015年4月-2016年4月医院重症监护室473例患者为研究对象,其中发生导管相关性血流相关感染(CRBSI)患者13例,随机选取非CRBSI患者26例为对照组,研究CRBSI患者流行病学特点及危险因素。结果共有动静脉插管398例,使用率为84.14%,13例发生CRBSI,感染率为2.75%;其中,两组患者的死亡数、平均年龄及糖尿病肾病对比差异有统计学意义(P<0.05),而动静脉置管,泌尿道置管等病因对比,差异无统计学意义;两组空腹血糖升高>6.1mmol/L水平,差异无统计学意义;CRBSI患者导管留置时间(14.24±2.12)d,急性生理与慢性健康评分(APACHE-Ⅱ)评分(22.30±5.40)分,CD4^+细胞(187.00±70.00)个/μl,体质量指数(BMI)(21.40±3.20)kg/m2,平均动脉压(MAP)(82.10±21.50)mmHg,ICU住院时间(10.30±2.50)d等指标都明显比非CRBSI患者差,两组对比差异有统计学意义(P均<0.05);导管留置时间,APACHE评分,CD4^+细胞,MAP等进行单因素与多因素分析这些指标差异有统计学意义(P<0.05)。结论对重症医学科导管相关血流感染患者,提高患者免疫力,缩短留置导管时间,降低MAP与APACHEⅡ评分及提升CD4^+细胞数量,可有效降低感染率。OBJECTIVE To analyze the epidemiological characteristics and risk factors of catheter-related bloodstream infections in ICU patients.METHODS A total of 473 patients who were treated in the intensive care unit from Apr 2015 to Apr 2016 were recruited as the study objects,of whom 13 had catheter-related bloodstream infections（CRBSI）,and 26 cases of non-CRBSI patients were randomly selected as control group.The epidemiological characteristics and risk factors of CRBSI patients were investigated.RESULTS Totally 398 cases were treated with arteriovenous intubation,with the rate of 84.14%,and 13 cases were with CRBSI,with the infection rate of2.75%.Among them,the number of deaths,the average age and diabetic nephropathy between the two groups were significently different（P〈0.05）,and there was no significant difference in the etiology of arteriovenous catheterization and urinary tract catheterization.There was no significant difference in fasting plasma glucose6.1mmol/l level between the two groups.The catheterization time,APACHE-Ⅱ score,CD4~＋cells,BMI,MAP and ICU hospital stay of CRBSI patients were（14.24±2.12）d,（22.30±5.40）points,（187.00±70.00）/μl,（21.40±3.20）kg/m2,（82.10±21.50）mmHg and（10.30±2.50）d,respectively,which were significantly worse than those of non-CRBSI patients（P〈0.05）.There were significant differences in the risk factors such as catheter retention time,APACHE score,CD4~＋cell,MAP and other factors in CRBSI patients by univariate and multivariable analysis（P 0.05）.CONCLUSIONIt can effectively reduce the infection rate by enhancing the immunity of the patients,shortening the catheter time,reducing the MAP and APACHE Ⅱscore and enhancing the number of CD4~＋cells in ICU patients with catheter-related bloodstream infection.

关 键 词：重症医学科 导管相关性血流感染 流行病学 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]